I am looking for some advice for the upcoming enrollment period to choose my insurance plan. My spouse and I are ~30, both employed, and are thinking about having kids in the next few years. We recently purchased a home in the suburbs. When we do have kids, my wife expect to continue working. We are both under our own insurance plans through work. My wife has a HDHCP plan through her employer (PPO is not an option), and currently contributes to an HSA. Typically, I have had about $600-800 in medical bills, and my wife is closer to $1000. I see a dermatologist twice a year, and occasionally get the flu or injure myself. I do not have any prescriptions, and neither does my wife. I do not wear glasses, but my wife does.
Below are my options:
- #1 – HDHCP with United Heathcare
Annual Cost:
Me: $636; Spouse: $948; Child: $516
Annual Deductible:
Single: $2,500
Family: $5,000
Coinsurance: 20% after deductible – no in/out of network
Annual out-of-pocket maximum:
Single: $5,000
Family: $10,000
Prescriptions: Pay at full cost until deductible is met
Access to HSA and limited purpose FSA for dental/vision costs.
- #2 – PPO with Blue Cross (lower tier)
Annual Cost:
Me: $1,248; Spouse: $1,884; Child: $1,008
Annual Deductible:
Single: $1,000 (in-network)
Family: $2,000 (in-network)
Coinsurance: 20% after deductible
Annual out-of-pocket maximum:
Single: $4,500
Family: $9,000
Prescriptions: Tiered co-pay structure
Access to FSA (cannot use as wife has HSA)
- #3 – PPO with Blue Cross (higher tier)
Annual Cost:
Me: $1,824; Spouse: $2,736; Child: $1,464
Annual Deductible:
Single: $600 (in-network)
Family: $1,200 (in-network)
Coinsurance: 10% after deductible; 50% out of network
Annual out-of-pocket maximum:
Single: $3,000
Family: $6,000
Prescriptions: Tiered co-pay structure
Access to FSA (cannot use as wife has HSA)
- Tier 1:
Annual Cost:
Me: $1,679; Spouse: 2,138 ;Child: 1,344; Family: 3,863
Annual Deductible:
Single: $1,500 (in-network)
Family: $3,000 (in-network)
Coinsurance: 15% after deductible (in-network); 50% out of network
Annual out-of-pocket maximum:
Single: $4,000
Family: $8,000
Prescriptions: Pay at full cost until deductible is met
Access to HSA, employer contributes $500
- Tier 2:
Annual Cost:
Me: $1,382; Spouse: 1,796;Child: 1,105; Family: 3,178
Annual Deductible:
Single: $1,500 (in-network)
Family: $3,000 (in-network)
Coinsurance: 25% after deductible (in-network); 50% out of network
Annual out-of-pocket maximum:
Single: $6,650
Family: $13,300
Prescriptions: Pay at full cost until deductible is met
Access to HSA, employer contributes $500
Thoughts/questions
- I have switched between the lower and higher tier PPO in the past. Based on my math, looks like the breakeven point for the lower and higher tier is ~$3,200 which I have never been close to spending. Lower tier looks to be optimal between the two.
- Between the lower tier PPO and HDHCP, the breakeven looks to be ~$1,750 before PPO is cheaper.
- Before we have kids, it appears the HDHCP plan is most likely going to be the cheapest by about $600 based on my history.
- Leading up to and in the year that we do have kids, it appears to me that it will likely be cheaper if I switch over to the PPO lower tier plan, and have my wife and kid(s) under such plan. Based on what I have heard, medical costs for child birth and first few years of the kid’s life can be expensive.
- If I were to go with the HDHCP, would I expect any difference in the actual rate that is charged to me by the doctor/hospital? It’s my understanding that the insurance company has negotiated rates on different procedures, but does this factor in?
- Any other overall thoughts? I am very open to ideas here.